Thorax

Radiologi
FK-UNIPA
RSUD-JPW Kabupaten Sorong
Radiologi Thorax
Pleura
Paru-paru
Jantung
Expertise foto thorax pasien dewasa
Foto thorax PA/AP :
- Corakan bronchovasculer (dbn/prominent)
- (Tampak/tidak tampak) proses spesifik pada kedua
lapangan paru
- Cor : membesar/CTI (cardio thoracic index) dalam batas
normal, aorta normal (dilatasi/elongasi/kalsifikasi)
- Kedua sinus dan diafragma (baik/tumpul/berselubung)
- Tulang-tulang (intak/ada fraktur)

Kesan :
Expertise foto thorax pasien anak
Foto thorax AP :
- Posisi (simetris/asimetris,) kondisi film (cukup,/kurang)
inspirasi (cukup/kurang)
- Corakan bronchovasculer (dalam batas
normal/prominent)
- (Tampak/ tidak tampak) pemadatan pada kedua hillus
- Cor : kesan (normal/tidak)
- Kedua sinus dan diafragma (baik/tumpul/berselubung)
- Tulang-tulang (intak/ada fraktur)
Kesan :
Pleura
Anatomi Pleura :
• Pleura parietal
• Pleura viseral
Rongga pleura : cairan pleura 2-5ml
(0.1-0.3/kgBB)
• diproduksi di pleura parietalis dari
pulmonary capillary bed
• diresorbsi di pleura parietalis dan pleura
viseralis
Efusi pleura

Penimbunan cairan berlebih di dalam

cavum pleura
• RLD :15-20 ml
• Lateral : 75 ml
• PA : 300 ml
Penyebab efusi pleura :
Produksi yang meningkat
• Peningkatan tekanan hidrostatik (ggl jtg
kiri)
• Penurunan tekanan osmotik koloid
• Peningkatan permeabilitas kapiler
Absorpsi menurun
• Blokade saluran limfe : oleh tumor
• Penurunan tekanan pada cavum pleura
Gambaran radiologi efusi pleura

Thorax foto CT scan

• Meniscus sign
• Sinus costofernicus tumpul
• Pendorongan organ mediastinum (masif)
Pneumothorax
Akumulasi udara dalam rongga pleura

Hiperlusen avasculer
Pleural white line
Pleural calcified/plaque
Paru-paru
Atelektasis
Kolaps paru
Mekanisme :
Obstruksi
Kompresi

Gb. Radiologi :
Opasitas pada hemithorax
Retraksi trachea/jantung, diafragma
RUL (lobus superior dextra) atelektasis
RML (lobus medius dextra) atelectasis
RLL (lobus inferior dextra) atelectasis
RL (paru dextra) atelectasis
LUL (lobus superior sinistra) atelectasis
LLL (lobus inferior sinistra)
LL (paru sinistra) atelectasis
TB Paru (TBC)
Infeksi oleh mycobaterium tuberculosis
Gb. radiologi :
 Konsolidasi
 Cavitas
 Bercak infiltrat
 Fibrosis
 Bintik-bintik kalsifikasi
(terutama pada apex paru/lapangan atas paru)
Konsolidasi dan cavitas
Infiltrat
Fibrosis
Bintik-bintik kalsifikasi
Bercak granuler tersebar pada kedua
lapangan paru
PPOK (emphysema pulmonum)
Akumulasi udara akibat obstruksi jalan napas yang
terjadi secara perlahan namun bersifat progresif.

GB. Radiologi :
• Hiperaerasi
• Sela iga melebar
• Diafragma mendatar
• Jantung ramping (bentuk pendulum)
Asma
Obstruksi saluran napas yang bersifat reversibel
• Edema mukosa
• Kontraksi otot polos
• Hipersekresi
Foto thorax :
pulmonary hyperinflation
bronchial wall thickening: peribronchial cuffing
 (non-specific finding but may be present in ~48%
of cases with asthma 1)
pulmonary oedema (rare): pulmonary oedema
due to asthma (usually occurs with acute asthma)
Bronchitis
Inflamasi pada dinding bronchus berukuran besar.
GB. Radiologi :
Corakan bronchovascular prominent (kasar)
Pneumonia
Infeksi paru (alveoli)
Etiologi :
Bakteri
Virus
Jamur

Gb. Radiologi :
- Konsolidasi
- Air Bronchogram Sign (ABS)
Bronchopneumonia
Infeksi paru (cabang-cabang bronchus)
GB radiologi :
Bercak infiltrat pada lapangan paru
 Bronchiolitis
Bronchiolitis refers to :
Inflammation and/or
Fibrosis
involving airways, typically bronchioles
(<2 mm in diameter, which often lack a
cartilaginous wall) and/or alveolar ducts
Bronchiolitis is not usually detected at chest
radiography. However, bronchiolitis may
manifest with nonspecific findings such as ill-
defined small or hazy clustered nodules or areas
of air trapping characterized by hyperlucency
and/or oligemia. CT images, on the other hand,
almost always demonstrate abnormal findings
that include centrilobular micronodules (often
seen as tree-in-bud opacities), bronchial wall
thickening, bronchiolar dilatation (often referred
to as bronchiolectasis), and mosaic attenuation
(and/or air trapping if expiratory imaging is used)
Infectious bronchiolitis in a 36-year-old man presenting with
fever, chest pain, and cough. (a) Posteroanterior chest radiograph
shows heterogeneous micronodular opacities (arrow) in the left
mid lung zone.
(b) Axial CT image shows clustered
branching tree-in-bud opacities (arrows) in
the left upper and lower lobes.
Bronchiectasis
Dilatasi bronchus yang bersifat irreversibel
• Cylindrik
• Varicose
• Cystic
Gambaran radiologi
• Cincin luscent
• Trem line
• Signet ring
Edema paru
Akumulasi cairan di paru
• Alveolar
• Interstitial
Gb radiologi :
• Perkabutan paracardial/parahilar (bat wing
appearance)
• Dilatasi vascular suprahilar (sefalisasi)
• Kerley B line (akumulasi cairan di sistem limfatik)
• Efusi pleura
• Doughnut sign/peribronchial cuffing (akumulasi
cairan disekitar cabang bronchus)
Kerley B line
Doughnut sign/peribronchial cuffing
Sefalisasi
Hipertensi pulmonal
Dilatasi arteri pulmonal (> 1.7 cm)
Hyalin membran disease (HMD)/RDS
(Bayi prematur-defisiensi surfaktan)
Transient Tachypnea of the Newborn (TTN)

Post sectio cesarea

(Gangguan pengeluaran cairan amnion dari paru)
Noncompress
Imbalace prostaglandin (DM/Asma)
X-Ray :
- Edema Interstitial
- Cardiomegaly
- Efusi pleura
Meconium Aspration Syndrome (MAS)
Serotinus
Jantung
Mitral Heart Disease (MHD)
Efusi pericard
Kelainan jantung bawaan (CHD)
Jantung (Cor)
Ukuran Normal
Cardiothoracic index (CTI)

Dewasa :
≤ 0.50 (PA) (0.42-0.5)
≤ 0.56 (AP)
Anak :
≤ 2 bln : 0.7
2 bln - <1 th : 0.58
1 th – 3 th : 0.53
> 3th : 0.5
Cardiothoracic Index (CTI)
Mitral stenosis
Left atrium enlargement (LAE)
 Main bronchus kiri terangkat
 Bayang ganda pada sisi kanan jantung
(Double contour)
Sefalisasi
Edema paru
Hypertensi arteri pulmonal
Mitral Insufisiensi
Akut :
 Edema paru, biasanya unilateral (RUL)
 Belum tampak cardiomegaly

Kronik :
 Pembesaran jantung kiri (volume overload) :
- Double density (kanan jantung)
- Main bronchus kiri terangkat
- Retrocardiac clear space menyempit (lateral)
- Sefalisasi
Efusi pericard
Gb radiologi :
Pembesaran jantung ke kiri dan ke kanan
(water bottle sign)
Kelainan jantung kongenital
Sianotik
Asianotik
Sianotik
Increased pulmonary vascularity
• Total
anomalous pulmonary venous return (TAP
VR)
 
• Transposition of the great arteries (TGA)
• Truncus arteriosus 
Decreased pulmonary vascularity
Tetralogy of Fallot
Ebstein anomaly with atrial septal defect
Total anomalous pulmonary venous
return (TAPVR)
In TAPVR, all systemic and pulmonary
venous blood enters the right atrium and
nothing drains into the left atrium.
A right-to-left shunt is required for survival
and is usually via a large patent foramen
ovale (PFO) or less commonly atrial septal
defect (ASD).
Type I: supracardiac
most common type (over 50% of cases)
anomalous pulmonary veins terminate at the supracardiac level
pulmonary veins converge to form a left vertical vein which then drains to
either brachiocephalic vein, SVC, or azygous vein
Type II: cardiac
second most common (~30% of cases)
pulmonary venous connection at the cardiac level
drainage is into the coronary sinus and then the right atrium
Type III: infracardiac
connection at the infracardiac level
the pulmonary veins join behind the left atrium to form a common vertical
descending vein
the common descending vein courses anterior to the esophagus passes through
the diaphragm at the esophageal hiatus and then usually join the portal system
drainage is usually into the ductus venosus, hepatic veins, portal vein, or IVC
Type IV: mixed pattern
least common type
anomalous venous connections at two or more levels
Snowman appearance
Transposition of the Great Arteries ( TGA)

Posisi aorta dan arteri pulmonal bertukar

Egg on string
Truncus Arteriosus
Collett and Edwards system
 type I: (most common) both aorta and main
pulmonary artery arise from a common trunk
 type II: pulmonary arteries arise separately from the
posterior aspect of trunk, close to each other just above
the truncal valve (negligible main pulmonary artery
segment)
 type III: (least common) pulmonary arteries arise
independently from either side of the trunk
 type IV: neither pulmonary arterial branch arising
from the common trunk (pseudotruncus), currently
considered a form of pulmonary atresia with a VSD
Tetralogy of Fallot
Tetralogy of Fallot is classically
characterized by four features which are:
• Ventricular septal defect (VSD)
• Right
ventricular outflow tract obstruction (RV
OTO
)
• Overriding aorta
• Right ventricular hypertrophy
Boot shaped hearth
Ebstein Anomaly
 The main abnormality is an abnormal tricuspid
valve (particularly septal and posterior leaflets),
which is displaced apically into the right ventricle
, resulting in atrialization of the parts of the
ventricle above the valve.
 This results from the tricuspid valve leaflets
inadequately separating from each other, or from
the chorda tendinae from the inferior portion of
the ventricle, during embryologic development.
 There can be concurrent tricuspid regurgitation
with or without stenosis.
Box shape
Asianotik :
Ventricular Septal Defect (VSD)
Atrial Septal Defect (ASD)
Patent Ductus Arteriosus (PDA)
VSD
The chest radiograph can be normal with a small VSD. 
Larger VSDs may show :
 Cardiomegaly
(particularly left atrial enlargement although
the right and left ventricle can also be
enlarged).
 Pulmonary arterial hypertension 
 Pulmonary edema
 Pleural effusion
 Increased pulmonary vascular markings.
 Aorta mengecil
ASD
can be normal in early stages when the atrial septal defect is
small
signs of increased pulmonary flow (pulmonary plethora or
shunt vascularity)
◦ enlarged pulmonary vessels
◦ upper zone vascular prominence
◦ vessels visible to the periphery of the film
◦ eventual signs of pulmonary arterial hypertension
chamber enlargement 
◦ right atrium
◦ right ventricle
◦ note: left atrium is normal in size unlike VSD or PDA
◦ note: aortic arch is small to normal
PDA
Dilatasi arteri pulmonal disertai pulmonary
plethora bilateral
Aorta normal/membesar
Cardiomegaly
PDA
TERIMA KASIH